First scrotal ultrasound examination: mildly enlarged left testis with heterogeneous echo pattern and increased vascularity. Mildly enlarged left epididymis. The right testis is normal in size, shape and echo pattern. Diagnosis of left epididymo-orchitis was raised; however, close observation and follow up ultrasound examination was recommended to exclude the possibility of underlying mass lesion. Unfortunately, the patient was lost to follow up.
Second scrotal ultrasound examination 3 years later: showed a large heterogeneous left testicular mass. No internal calcifications or cystic components are seen. It has mild internal vascularity on Doppler ultrasound examination. Enlarged and heterogeneous left epididymis, being invaded by the testicular mass. Large left para-aortic nodal mass measuring 9 x 9 cm at the level of left renal hilum.